Democratic Republic of Congo (DRC)
In 2019, Doctors Without Borders (MSF) teams worked in 21 of DRC’s 26 provinces, providing a wide range of services including general and specialist healthcare, nutrition, vaccinations, surgery, paediatric care, support for victims of sexual violence, as well as treatment and prevention activities for HIV/AIDS, tuberculosis (TB), measles, cholera and Ebola.
The world’s largest measles epidemic
The measles outbreak, the largest recorded, has ravaged DRC since mid-2018 and was declared a national epidemic by the Congolese government in June 2019. According to the World Health Organization, in 2019, more than 310,000 people contracted measles and over 6,000 died from the disease in DRC. MSF’s response included support for local surveillance activities, mass vaccination campaigns and treatment for complicated cases in 16 provinces: North and South Kivu, Bas-Uélé, Kasai, Kasai Central, Kwilu, Mai-Ndombe, South Ubangi, Tshopo, Tshuapa, Ituri, Kongo Central and the four ex-Katanga provinces. Our teams vaccinated over 679,500 children and treated some 48,000 in our facilities.
Measles is a vaccine-preventable disease but the failure to cover all health zones with routine vaccination and the delay in organising supplementary campaigns are among the reasons this outbreak is so big. In DRC, factors contributing to low coverage include the lack of vaccines, vaccinators and access to healthcare facilities, as well as logistical difficulties such as transport. The outbreak occurred at the same time as the Ebola epidemic, which complicated the response.
Activities in Democratic Republic of Congo in 2019
Five-year-old Souffrance undergoes treatment at the MSF-run measles unit at Biringi Hospital, Ituri province. Democratic Republic of Congo, November 2019.
Assisting displaced people
Longstanding intercommunal violence in Ituri flared up again in Djugu and Mahagi territories, displacing over a million people. At the end of the year, around 200,000 people were sheltered in some 80 makeshift sites, where the living conditions were extremely poor. Our teams provided medical care and distributed water, mosquito nets and relief items at around 30 sites.
Until February, we continued supporting health facilities in Mai-Ndombe, following two days of intercommunity violence in December 2018, during which there were many casualties. We treated injuries and burns, ran mobile clinics and distributed relief items to around 2,850 displaced households. In North Kivu, we assisted displaced people in four camps through mobile clinics and water, hygiene and sanitation activities. In Kasai Central, we ran mobile clinics and health promotion activities to assist Congolese people pushed out of neighbouring Angola.
Comprehensive care in the Kivu provinces
In the Kivu provinces, which have been plagued by conflict for many years, MSF has maintained some long-term projects that ensure continuity of care, while also responding to epidemics, mass displacement and other emergencies.
In North Kivu, our teams operate in Goma, Mweso, Walikale, Masisi, Rutshuru, Bambu and Kibirizi health zones to support the delivery of general and specialist healthcare in hospitals, health centres and posts, and through mobile clinics and community-based outreach activities. Our services include emergency and intensive care, surgery, referrals, neonatal, paediatric and maternal healthcare, mental health support, HIV and TB programmes, vaccinations, nutrition and treatment for sexual and gender-based violence.
In South Kivu, we support hospitals and health centres in Baraka and, Mulungu, Kalehe and Kimbi-Lulenge health zones, offering treatment for malnutrition, HIV, TB and other infectious diseases, mental health support, and maternal and reproductive healthcare. In Baraka and Kimbi we work closely with communities to respond to the three main illnesses affecting the population; malaria, diarrhoea and respiratory tract infections. In 2019, we started constructing a new hospital in Baraka and upgraded Kusisa and Tushunguti hospitals by installing a solar energy system.
Treating victims of sexual violence
We have teams working in clinics in both Kivu provinces, as well as Kasai Central, Maniema and Ituri, offering reproductive healthcare, including safe abortion care, and medical and psychological treatment for victims of sexual and gender-based violence. With multiple forms of violence often perpetrated at community level, MSF is training people to be first responders, or trusted focal points, for victims in their own communities. In Kimbi-Lulenge and Kamambare health zones (South Kivu), and in Salamabila (Maniema), Masisi (North Kivu) and Kananga (KasaiCentral), MSF works with 88 such focal points. Most are female, as the majority of victims are women and girls. MSF tries to tackle the prejudice that leads to stigma and even family rejection, and tries to organise referrals to other organisations who can offer socioeconomic assistance.
Activities in Democratic Republic of Congo in 2019
The MSF Health Promotion team visits local markets and IDP camps to raise awareness about malaria, cholera, and sexual violence, and inform people of the free healthcare provided in MSF-supported local health centers, October 2019
Responding to epidemics
Throughout the year, our teams supported the national response to large cholera outbreaks across both Kivu provinces. Our teams treated patients in cholera treatment centers (CTCs) and ensured that they and their carers were made aware of good hygiene and sanitation practices to reduce the risk of spreading. We also carried out epidemiological surveys and donated medicines. During an outbreak between May and September, we opened a temporary CTC in Kyeshero (Goma), Lubumbashi (Katanga), and four more in Masisi, where we treated almost 700 patients in one month, most of them displaced people living in precarious conditions in camps.
Malaria also continues to be a major health issue in DRC. At Baraka hospital in South Kivu, we increase treatment capacity every year with 100 beds to respond to the seasonal peak. In 2019, we introduced larvicide spraying in mosquito breeding hotspots as a preventive strategy. In the Bili health zone, North Ubangi, where malaria is hyper-endemic, our teams ran a project across 62 health facilities focused on treating young children.
HIV/AIDS remains another deadly threat in DRC, with less than 60 percent of people living with the disease having access to antiretroviral (ARV) treatment. Limited ARV supply, lack of information and prevention services, stigma, and cost are some of the obstacles to care.
In the capital, Kinshasa, and Goma, we support 11 healthcare facilities to expand access to HIV treatment and screening, strengthen follow-up, and ensure a steady supply of ARVs. In Kinshasa, we provided medical and psychosocial care for 3,167 HIV-positive patients at Kabinda hospital and seven other facilities. At the Misisi health centre in South Kivu, MSF community health educators are part of an HIV support group called the Social Committee for Health Promotion, which raises awareness and fights stigma in the community. In 2019, the group followed 1,821 patients registered in HIV programs in Misisi, Lulimba, and Nyange health centres.
Throughout 2019, we continued our advocacy efforts to address the lack of bed capacity for advanced HIV/AIDS patients, tackle ARV stockout problems, and enhance specialist care for pediatric patients.
No. staff in 2019: 3,173 | Expenditure in 2019: €133.1 million | Year MSF first worked in the country: 1977